| NPI | 1952039133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.187704) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH 0003140) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2024-04-23 |