| NPI | 1295254373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA163104) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162028) |
| 1041C0700X Social Worker, Clinical (Licence: OH I.2203743) | |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2023-01-18 |