| NPI | 1417437039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2207362) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 167042) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2022-03-09 |