| NPI | 1316409360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH 006748) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: OH CDCA.169978) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2025-12-02 |