| NPI | 1164962031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I.2204169) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.141762) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LICDC162119) | |
| 104100000X Social Worker (Licence: OH S.1904462) | |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2023-01-20 |