| NPI | 1396494761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCAPRE.195775) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH PRS.005700) |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2026-09-22 |