| NPI | 1154779783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.161582) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2024-05-31 |