| NPI | 1871039214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.0020717) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 965817) |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2023-09-25 |