| NPI | 1447702022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.1803147) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LICDC.162513) |
| Enumeration Date | 2016-10-28 |
| Last Update Date | 2023-12-04 |