| NPI | 1811527237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 172564) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OH 172564) |
| Enumeration Date | 2020-01-24 |
| Last Update Date | 2020-01-24 |