| NPI | 1023689353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S2613763) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII161958) | |
| Enumeration Date | 2021-07-07 |
| Last Update Date | 2026-06-26 |