| NPI | 1831553965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LICDC.872388) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH S-0018686) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2024-05-06 |