| NPI | 1134007594 |
|---|---|
| Former Name | ERICA ELIZABETH MEDINA |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.192777) |
| Enumeration Date | 2025-08-25 |
| Last Update Date | 2025-08-25 |