| NPI | 1457124398 |
|---|---|
| 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.183535) |
| Enumeration Date | 2023-11-02 |
| Last Update Date | 2023-11-02 |