| NPI | 1598499626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 175T00000X Peer Specialist (Licence: OH APS.003298) | |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2023-01-12 |