| NPI | 1821502063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 168922) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 164469) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-11-27 |
| Last Update Date | 2019-07-01 |