| NPI | 1669030318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.028701) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.2304483) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162437) | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2026-04-21 |