| NPI | 1659315745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 841108) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I0000472) |
| 1041C0700X Social Worker, Clinical (Licence: KY KY-1034) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2007-07-09 |