| NPI | 1487318002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162623) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S2303013-TRNE) |
| Enumeration Date | 2021-10-29 |
| Last Update Date | 2024-06-05 |