| NPI | 1083188643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.183151) |
| 104100000X Social Worker (Licence: OH S.2202740-TRNE) | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2024-04-19 |