| NPI | 1467471904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I-0008399) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 981337) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2018-08-19 |