NPI | 1003329087 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.161825) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OH CDCA.169543) |
Enumeration Date | 2017-11-13 |
Last Update Date | 2022-11-09 |