| NPI | 1376901348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.161129) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 161129) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2021-08-10 |