| NPI | 1720850381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2406205-TRNE) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.184824) |
| 172V00000X Community Health Worker | |
| 175T00000X Peer Specialist (Licence: OH APS.004570) | |
| Enumeration Date | 2023-10-26 |
| Last Update Date | 2025-05-13 |