| NPI | 1053913830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.179725) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 104100000X Social Worker (Licence: OH S.2404035-TRNE) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2025-01-24 |