| NPI | 1336717362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.183213) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2023-05-02 |