| NPI | 1679280010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.186279) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.182209) |
| 171M00000X Case Manager/Care Coordinator | |
| 175T00000X Peer Specialist (Licence: OH APS.003261) | |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2024-01-02 |