| NPI | 1306365424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH 00284) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: 00284) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2017-09-11 |