| NPI | 1447791637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH cdca.162251) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OH CDCA.162251) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2018-05-31 |