| NPI | 1730519802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH S. 1201028) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 021082) |
| 104100000X Social Worker (Licence: OH S. 1201028) | |
| 101YM0800X Counselor, Mental Health (Licence: OH 51201028) | |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2014-10-27 |