| NPI | 1700374642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.166913) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH CDCA.166913) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2018-06-04 |