| NPI | 1528571643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162327) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 080164) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.161999) | |
| 101YM0800X Counselor, Mental Health (Licence: OH QMHS) | |
| 175T00000X Peer Specialist (Licence: OH 00493) | |
| Enumeration Date | 2017-11-11 |
| Last Update Date | 2023-03-07 |