| NPI | 1538736897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.182870) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2023-09-05 |