| NPI | 1407610967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 405300000X Prevention Professional (Licence: OH RA.163851) | |
| Enumeration Date | 2024-02-06 |
| Last Update Date | 2025-07-21 |