| NPI | 1164230124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.193340) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS.004334) |
| Enumeration Date | 2024-12-23 |
| Last Update Date | 2025-09-19 |