| NPI | 1184153371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I1200438SUPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC161146) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2022-07-21 |