| NPI | 1851989156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 000730036) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2021-01-04 |
| Last Update Date | 2023-11-14 |