NPI | 1710697321 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.182780) |
Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS.003735) |
Enumeration Date | 2022-12-05 |
Last Update Date | 2022-12-05 |