| NPI | 1255875522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.161595) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OH W.1600042) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-12-06 |
| Last Update Date | 2023-02-28 |