| NPI | 1649922824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162795) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.2411579) |
| Enumeration Date | 2022-01-19 |
| Last Update Date | 2025-12-28 |