| NPI | 1740790443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 976173) |
| Enumeration Date | 2017-10-07 |
| Last Update Date | 2026-08-01 |