| NPI | 1790337889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162187) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 167782) |
| 104100000X Social Worker (Licence: OH S.2207483) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2022-05-03 |