| NPI | 1003314113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.110082) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 175T00000X Peer Specialist (Licence: OH APS.004553) | |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2024-08-13 |