| NPI | 1285367615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: OH CDCA.185627) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.181820) |
| 175T00000X Peer Specialist (Licence: OH APS.003366) | |
| Enumeration Date | 2022-07-04 |
| Last Update Date | 2024-02-01 |