| NPI | 1861151870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH APS.004099) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: OH 179237) |
| Enumeration Date | 2021-12-17 |
| Last Update Date | 2023-09-07 |