| NPI | 1396190542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.193464) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS.006591) |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2025-08-27 |