| NPI | 1619773538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH APS.005688) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA191060) |
| Enumeration Date | 2025-02-21 |
| Last Update Date | 2025-12-12 |