| NPI | 1720640709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.174561) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2024-07-01 |