| NPI | 1144183831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCAPre.195144) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS.006127) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2025-12-08 |
| Last Update Date | 2026-06-07 |