| NPI | 1932414117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC-CS.021359) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2026-06-19 |