| NPI | 1417549858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH W.2600511) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2026-01-29 |