| NPI | 1598547556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 187844) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH 003892) |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2024-03-26 |