| NPI | 1174030654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162494) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker (Licence: OH s.2207357) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-01-05 |
| Last Update Date | 2023-11-07 |