NPI | 1952039133 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.187704) |
Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH 0003140) |
175T00000X Peer Specialist | |
Enumeration Date | 2022-08-15 |
Last Update Date | 2024-04-23 |