| NPI | 1700547452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.179423) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OH CDCA.179423) |
| Enumeration Date | 2022-01-05 |
| Last Update Date | 2025-06-20 |