| NPI | 1255821245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH S.1802791) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 166234) |
| 104100000X Social Worker (Licence: OH S.1802791) | |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2019-04-10 |