| NPI | 1417458134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2304984-SUPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162220) |
| 104100000X Social Worker (Licence: OH S.2106128) | |
| Enumeration Date | 2018-02-27 |
| Last Update Date | 2025-06-21 |