NPI | 1548823768 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 090605) |
Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH 0002286) |
Enumeration Date | 2019-04-15 |
Last Update Date | 2023-11-10 |