| NPI | 1477114627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.175106) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 175T00000X Peer Specialist (Licence: OH APS.005765) | |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2025-01-11 |