| NPI | 1245920362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.185208) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 175T00000X Peer Specialist (Licence: OH APS.004270) | |
| Enumeration Date | 2023-05-11 |
| Last Update Date | 2023-10-17 |