| NPI | 1982461596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.194560) | |
| Enumeration Date | 2024-02-29 |
| Last Update Date | 2026-02-08 |