| NPI | 1316556913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC162815) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH 0001916) |
| 104100000X Social Worker (Licence: OH S.2308951) | |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2026-05-30 |