| NPI | 1407369606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 130185) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2017-11-09 |
| Last Update Date | 2018-12-17 |