| NPI | 1689163958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2202732-TRNE) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.162612) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162452) | |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2023-01-17 |