| NPI | 1962161141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.163025) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.2614378) |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2026-07-23 |