| NPI | 1639610595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH 000120) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 165555) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2024-12-05 |