| NPI | 1235879123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.184049) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 106S00000X Behavior Technician | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2024-01-29 |