| NPI | 1417481839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161432) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1302069) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2025-07-31 |