| NPI | 1760233654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162632) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH W.2400401) |
| Enumeration Date | 2024-03-28 |
| Last Update Date | 2024-03-28 |