| NPI | 1619554730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.176693) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.181072) | |
| 171M00000X Case Manager/Care Coordinator (Licence: OH 2021) | |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2022-12-02 |