| NPI | 1386389211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162666) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.2208196) |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2026-03-25 |