| NPI | 1972081719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCAPre.195363) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2026-04-06 |