| NPI | 1174780183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH s.0500567) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 011389) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2019-03-07 |