| NPI | 1285850073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1801033) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 021251) |
| 104100000X Social Worker (Licence: OH 1600327) | |
| 104100000X Social Worker (Licence: OH I.1801033) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2019-05-08 |