| NPI | 1487126512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162448) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.161814) |
| 104100000X Social Worker (Licence: OH S.2208531) | |
| 104100000X Social Worker (Licence: OH W.2000232) | |
| Enumeration Date | 2018-12-31 |
| Last Update Date | 2022-12-13 |