| NPI | 1740007640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.191170) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OH 2024) |
| 175T00000X Peer Specialist (Licence: OH APS.005388) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: OH 2025) | |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2025-04-24 |