| NPI | 1093391906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH APS.002337) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.185186) |
| 101YM0800X Counselor, Mental Health (Licence: OH QMHS.HSGED) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.181097) | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2024-11-22 |