| NPI | 1881217545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH S.2411551) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.162023) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2025-02-21 |