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 |