| NPI | 1093179897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH s-0024418) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 021324) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2016-08-03 |