| NPI | 1508472952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OH Uh804004) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 176595) |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2024-06-17 |