| NPI | 1013862804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH PRS.007899) |
| Enumeration Date | 2026-02-27 |
| Last Update Date | 2026-06-16 |