| NPI | 1396362539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162576) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS.003178) |
| Enumeration Date | 2020-07-04 |
| Last Update Date | 2023-09-29 |