NPI | 1568153351 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.185075) |
Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS.004147) |
Enumeration Date | 2023-05-15 |
Last Update Date | 2023-07-05 |