| NPI | 1619451101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH S.2005265) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.173713) |
| 1041C0700X Social Worker, Clinical (Licence: OH S.1901088-TRNE) | |
| Enumeration Date | 2018-09-20 |
| Last Update Date | 2020-08-03 |