| NPI | 1649017583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH APS.005315) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 190842) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2024-07-09 |
| Last Update Date | 2024-12-05 |