| NPI | 1548823768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 090605) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH 0002286) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2023-11-10 |