| NPI | 1275878456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH 1451267) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 981266) |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2023-12-15 |