| NPI | 1255095691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LCDCII.161876) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.2512865) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.182243) | |
| Enumeration Date | 2021-10-22 |
| Last Update Date | 2025-08-26 |