| NPI | 1568018422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.171405) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: QMHS) |
| 171M00000X Case Manager/Care Coordinator (Licence: CMS) | |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2019-09-23 |