| NPI | 1891267506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH S.1803028) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162439) |
| 175T00000X Peer Specialist (Licence: OH APS.003561) | |
| Enumeration Date | 2018-12-19 |
| Last Update Date | 2022-11-29 |