| NPI | 1912514019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH C.2203820-TRNE) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH C2203820-TRNE) |
| 175T00000X Peer Specialist (Licence: OH 0002025) | |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2022-01-25 |