| NPI | 1699669887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCAPre.196429) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS.006475) |
| Enumeration Date | 2025-06-04 |
| Last Update Date | 2026-06-24 |