| NPI | 1356852834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH APS.000486) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.168817) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2024-02-02 |