| NPI | 1649740812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2204144-TRNE) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.166633) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-11-30 |
| Last Update Date | 2024-05-17 |