| NPI | 1720841596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.170850) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2024-02-02 |
| Last Update Date | 2026-09-01 |