NPI | 1649759762 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.179639) |
251S00000X | |
Enumeration Date | 2018-08-09 |
Last Update Date | 2022-11-21 |