| NPI | 1629549423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162257) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH W.1800116) |
| 171M00000X Case Manager/Care Coordinator (Licence: OH CDCA.166069) | |
| Enumeration Date | 2018-12-06 |
| Last Update Date | 2021-09-14 |