| NPI | 1972063246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.177328) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH QMHS) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2021-09-29 |