| NPI | 1750513040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 081184) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 81184-CS) | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2025-07-08 |