NPI | 1407638489 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.186434) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OH 0000000) |
Enumeration Date | 2023-10-16 |
Last Update Date | 2024-10-04 |