| NPI | 1871325720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 189578) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS006603) |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2025-04-03 |