| NPI | 1558020669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OH CDCA.180288) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS.002340) |
| Enumeration Date | 2021-12-16 |
| Last Update Date | 2022-04-08 |