NPI | 1821587775 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.165456) |
Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH CDCA.165456) |
Enumeration Date | 2018-05-07 |
Last Update Date | 2018-06-06 |