| NPI | 1639253271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I0700242) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 071035) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0718000152) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904003944) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2007-10-15 |