| NPI | 1649062076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 172A00000X Driver (Licence: OH RS528786) |
| Enumeration Date | 2025-05-21 |
| Last Update Date | 2026-09-14 |