| NPI | 1033927090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.191221) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2024-12-23 |
| Last Update Date | 2025-04-12 |