| NPI | 1285130468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.110736) |
| 104100000X Social Worker (Licence: OH S.2303110-TRNE) | |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2026-01-14 |