| NPI | 1972792000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.0004969-SUPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 933726) |
| 1041C0700X Social Worker, Clinical (Licence: OH S.0016762) | |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2017-03-28 |