| NPI | 1861800898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH I.2405857) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.2405857) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162569) | |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2025-12-10 |