| NPI | 1497267116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH 00678) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OH CDCA.164909) |
| Enumeration Date | 2017-11-03 |
| Last Update Date | 2019-10-04 |