| NPI | 1316766694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.194944) |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2024-10-04 |
| Last Update Date | 2026-01-20 |