| NPI | 1538851316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH W2300389) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA183583) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2024-03-22 |