| NPI | 1669030318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I.2304483) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162437) | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2024-08-28 |