| NPI | 1285105189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2507186) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.181777) |
| 104100000X Social Worker (Licence: OH S.2308747) | |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2025-09-17 |