| NPI | 1063922490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 162011) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 150053) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.150053) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2024-05-21 |