| NPI | 1598243446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 164719) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH QMHS) |
| 171M00000X Case Manager/Care Coordinator (Licence: OH CMS) | |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2018-11-24 |