| NPI | 1083509871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.0700201-SUPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.031079) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801120206) | |
| 171M00000X Case Manager/Care Coordinator (Licence: OH CS.00001302) | |
| Enumeration Date | 2025-06-11 |
| Last Update Date | 2026-01-23 |