| NPI | 1104371996 |
|---|---|
| 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 CDCA170844) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2025-02-24 |