| NPI | 1912764184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.191448) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.187391) |
| 175T00000X Peer Specialist (Licence: OH APS.004479) | |
| Enumeration Date | 2024-03-04 |
| Last Update Date | 2025-01-30 |