| NPI | 1972042471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162134) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.170068) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2025-10-30 |