| NPI | 1043957301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162756) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162608) |
| 101YM0800X Counselor, Mental Health (Licence: OH C.2507000) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2025-06-30 |