| NPI | 1902567886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.182786) |
| 175T00000X Peer Specialist (Licence: OH APS.003756) | |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2023-10-17 |