| NPI | 1700305489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.2103246) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.172119) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-09-14 |
| Last Update Date | 2022-07-21 |