| NPI | 1407419724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.162077) |
| 101Y00000X Counselor | |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2025-08-11 |