| NPI | 1003318734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH 00435) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: OH RA.161611) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.166229) | |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2018-03-08 |