| NPI | 1306983341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH I.0500057.SPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 976250) |
| 1041C0700X Social Worker, Clinical (Licence: OH 10500057) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2021-02-24 |