| NPI | 1124407531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH 2002833) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 130327) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2020-08-24 |