| NPI | 1275199184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH APS.001293) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.170523) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2022-12-01 |