| NPI | 1932758430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162542) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-05045) |
| 104100000X Social Worker (Licence: MI 6801117351) | |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2025-06-15 |