| NPI | 1588168041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1300423) |
| 175T00000X Peer Specialist (Licence: OH 136) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2023-03-01 |