| NPI | 1730646712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH APP-000218442) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 170009) | |
| Enumeration Date | 2019-02-26 |
| Last Update Date | 2024-04-22 |