| NPI | 1831741289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.162051) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH W.2400457) |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2026-01-15 |