| NPI | 1427633411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OH 180516) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.180516) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2021-03-11 |
| Last Update Date | 2023-02-21 |