| NPI | 1801301130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.168912) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH 00510) |
| 101YM0800X Counselor, Mental Health (Licence: QMHS) | |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2021-08-05 |