| NPI | 1861273575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.190402) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS004231) |
| Enumeration Date | 2023-10-09 |
| Last Update Date | 2024-11-05 |