| NPI | 1447903760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.186338) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2024-05-22 |