| NPI | 1932033412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH PRS.008122) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCAPre.196278) |
| Enumeration Date | 2026-06-10 |
| Last Update Date | 2026-09-09 |