| NPI | 1205653334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2504411-TRNE) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| Enumeration Date | 2024-09-20 |
| Last Update Date | 2025-08-21 |