| NPI | 1023257573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.011119) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1100423) |
| Enumeration Date | 2009-02-06 |
| Last Update Date | 2023-11-02 |