| NPI | 1366421844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E0003359SUPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC954432) |
| 104100000X Social Worker (Licence: OH S0020189) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2019-08-21 |