| NPI | 1609853753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1302017) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 001182) |
| 1041C0700X Social Worker, Clinical (Licence: OH W909) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2025-01-28 |