| NPI | 1063138576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 261QM0801X (Licence: OH QMHS) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.182001) | |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2023-10-10 |