| NPI | 1871132472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.172261) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS003133) |
| Enumeration Date | 2019-12-30 |
| Last Update Date | 2025-01-07 |