| NPI | 1790507135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS.005571) |
| Enumeration Date | 2024-10-28 |
| Last Update Date | 2025-09-22 |