| NPI | 1902319023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 163464) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH prs.00394) |
| 101YM0800X Counselor, Mental Health (Licence: OH QMHS) | |
| Enumeration Date | 2017-11-11 |
| Last Update Date | 2018-11-20 |