| NPI | 1013898659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.196363) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH PRS.008394) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2025-09-10 |
| Last Update Date | 2026-10-01 |