| NPI | 1215720917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.193320) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS.006461) |
| Enumeration Date | 2025-05-26 |
| Last Update Date | 2025-08-06 |