| NPI | 1922851153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH Tv036006) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2024-04-08 |
| Last Update Date | 2024-04-12 |