| NPI | 1740482835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH s1145) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 78111) |
| 101YM0800X Counselor, Mental Health (Licence: OH E626) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2025-09-11 |