| NPI | 1265999791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 168716) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH 000941) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2023-03-27 |