| NPI | 1821566175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.177980) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: OH 00693) |
| 175T00000X Peer Specialist (Licence: OH APS.000693) | |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2023-06-29 |