| NPI | 1780249219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S-1302484) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH S-1302484) |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2026-07-22 |