| NPI | 1508343567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 167739) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS.000657) |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2023-07-20 |