| NPI | 1588110522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AZ LCSW-20143) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LICDC.161348) |
| 1041C0700X Social Worker Clinical (Licence: OH I. 1700317) | |
| 1041C0700X Social Worker Clinical (Licence: OH I.1700317-SUPV) | |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2023-02-21 |