| NPI | 1194421990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH APS.004956) |
| Additional Taxonomies | 261QM0801X (Licence: OH QMHS) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.183139) | |
| Enumeration Date | 2023-02-02 |
| Last Update Date | 2024-04-03 |