| NPI | 1902781107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.192076) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2025-08-07 |
| Last Update Date | 2025-09-22 |