| NPI | 1497457261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106S00000X Behavior Technician | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.186354) | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2023-03-17 |
| Last Update Date | 2025-01-22 |