| NPI | 1558108902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2405121) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162414) |
| 405300000X Prevention Professional (Licence: OH OCPC.161330) | |
| Enumeration Date | 2024-07-12 |
| Last Update Date | 2024-07-12 |