| NPI | 1023752144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.193308) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2025-08-12 |