| NPI | 1427539519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH LCDCII.162062) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH PRS.007460) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2026-04-07 |