| NPI | 1730825761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.186789) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS.003667) |
| 171M00000X Case Manager/Care Coordinator | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2024-01-04 |