| NPI | 1184086720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH S.0014421) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH ICDC.965668-CS) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 965668) | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2025-06-23 |