| NPI | 1427920370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCAPre.195406) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS-006871) |
| 175T00000X Peer Specialist (Licence: OH FPS.000381) | |
| Enumeration Date | 2025-09-20 |
| Last Update Date | 2026-03-14 |