| NPI | 1891662664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.194607) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH 75598602) |
| Enumeration Date | 2025-10-17 |
| Last Update Date | 2026-06-12 |