| NPI | 1023464682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I1801316) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 0012311) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 011229) | |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2018-11-30 |