| NPI | 1588161897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH I.2405303) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162384) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2024-04-01 |