| NPI | 1982555660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCAPre.195571) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 175T00000X Peer Specialist (Licence: OH PRS.007479) | |
| Enumeration Date | 2026-02-07 |
| Last Update Date | 2026-03-30 |