| NPI | 1508414186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162140) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1903396) |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2025-03-03 |