| NPI | 1144994245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.179416) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172V00000X Community Health Worker | |
| 246Z00000X Specialist/Technologist, Other | |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2022-02-28 |