| NPI | 1083125918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA172985) |
| 376K00000X Nurse's Aide (Licence: OH 401563210813) | |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2026-03-23 |