| NPI | 1922514090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH 0001707) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.167583) |
| 104100000X Social Worker (Licence: OH S.2005154) | |
| Enumeration Date | 2017-12-27 |
| Last Update Date | 2020-07-15 |