| NPI | 1194340935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII161844) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS001511) |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2023-06-05 |