| NPI | 1023941093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.194468) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS.006775) |
| Enumeration Date | 2026-06-08 |
| Last Update Date | 2026-06-08 |