| NPI | 1598482101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH APS.004968) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2024-04-03 |