| NPI | 1235750241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2405182) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 169912) |
| 104100000X Social Worker (Licence: OH S.2001335-TRNE) | |
| 104100000X Social Worker (Licence: OH S.2106261) | |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2024-09-30 |