| NPI | 1821193764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1303536) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I1303536) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 954269) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CS954269) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2014-08-07 |