| NPI | 1063951556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I.2103221-SUPV) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LICDC.161869) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LCDCIII.161749) | |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2023-03-25 |