| NPI | 1609033927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I3225) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 872299) |
| 101YM0800X Counselor Mental Health (Licence: OH E1379) | |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2008-05-22 |