| NPI | 1902940208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1800698-SUPV) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.0027140) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 975843) | |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2025-04-16 |