| NPI | 1922586965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: OH OSCPA.161573) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.162050) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2025-05-12 |