| NPI | 1588139125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH S.1800373-TRNE) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 104100000X Social Worker | |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2026-02-13 |