| NPI | 1659904142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.175597) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OH CDCA.172215) |
| Enumeration Date | 2020-02-13 |
| Last Update Date | 2026-09-10 |