| NPI | 1336750579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH s.2411724) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 162298) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2024-12-20 |