| NPI | 1972230688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH LICDC.161755) |
| 104100000X Social Worker (Licence: OH CDCA.178466) | |
| Enumeration Date | 2022-08-03 |
| Last Update Date | 2022-08-05 |