| NPI | 1710585369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 173070) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 174628) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2020-10-15 |
| Last Update Date | 2021-07-16 |