| NPI | 1285269423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.178037) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: OH QMHS) |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2023-01-26 |