NPI | 1609853753 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 001182) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH W909) |
Enumeration Date | 2005-12-29 |
Last Update Date | 2007-07-08 |