| NPI | 1922828623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 191776) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH 005331) |
| Enumeration Date | 2024-10-16 |
| Last Update Date | 2025-02-26 |