| NPI | 1407536154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.185076) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YM0800X Counselor, Mental Health (Licence: QHMS) | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2023-07-18 |
| Last Update Date | 2025-12-18 |