| NPI | 1306512132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 180368) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH 0002753) |
| Enumeration Date | 2021-08-20 |
| Last Update Date | 2022-04-21 |