| NPI | 1043711658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.171244) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.166882) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2020-01-24 |