| NPI | 1902576416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.189657) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OH 189657) |
| Enumeration Date | 2021-09-16 |
| Last Update Date | 2025-11-20 |