| NPI | 1669163929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH APS.004149) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: 171M00000X) |
| 171M00000X Case Manager/Care Coordinator (Licence: OH Aps.oo4149) | |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2023-12-28 |