| NPI | 1922708700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.188552) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2024-06-18 |