| NPI | 1578002499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH 0002623) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.162615) |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2023-07-30 |