| NPI | 1578976700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.1450618) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 130159) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LICDC.162364) | |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2023-07-18 |