| NPI | 1548431596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S0028439) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 001190) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2008-03-25 |