| NPI | 1699285080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH I.1901760-SUPV) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: OH s1600315) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161805) | |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2020-12-07 |