| NPI | 1851630875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.0013531) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC 933671-CS) |
| Enumeration Date | 2013-02-12 |
| Last Update Date | 2016-09-16 |