| NPI | 1255984001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH S.2207409) |
| Additional Taxonomies | 104100000X Social Worker |
| 104100000X Social Worker (Licence: OH S.2207409) | |
| 171M00000X Case Manager/Care Coordinator | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2025-05-20 |