| NPI | 1942804927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.181053) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2023-07-25 |