| NPI | 1255849758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH S.2005634) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 162422) |
| 175T00000X Peer Specialist (Licence: OH APS.000660) | |
| 101Y00000X Counselor (Licence: OH LCDCIII.162264) | |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2023-05-03 |