NPI | 1871914689 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.0031525-S) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 111012-CS) |
Enumeration Date | 2013-12-20 |
Last Update Date | 2013-12-20 |