| NPI | 1275797508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 173323) |
| 175T00000X Peer Specialist (Licence: OH 0001797) | |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2024-05-02 |