| NPI | 1659797942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1500230) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH ICDC.121149-CS) |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2016-05-21 |