| NPI | 1326664046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH PRS.004896) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2026-08-24 |