NPI | 1124535752 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 175T00000X Peer Specialist |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 165372) |
Enumeration Date | 2018-01-04 |
Last Update Date | 2023-04-18 |