| NPI | 1063055911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH cdca.174888) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 170583) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2021-02-08 |