| NPI | 1447987128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.183804) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 175T00000X Peer Specialist (Licence: OH APS.006713) | |
| Enumeration Date | 2022-08-03 |
| Last Update Date | 2025-08-11 |