| NPI | 1699203752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 162832) |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2025-08-14 |