| NPI | 1841935764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCD.180502) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.2512814) |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2025-08-22 |