| NPI | 1619719689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 175T00000X Peer Specialist (Licence: OH APS005020) | |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2024-11-29 |