| NPI | 1629451968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 1629451968) |
| Additional Taxonomies | 251B00000X Case Management (Licence: OH 1629451968) |
| 101Y00000X Counselor (Licence: OH 1629451968) | |
| 171M00000X Case Manager/Care Coordinator (Licence: OH 1629451968) | |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2015-07-08 |