| NPI | 1225787781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.187231) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 182925) |
| 175T00000X Peer Specialist (Licence: OH 002949) | |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2025-06-09 |