| NPI | 1669206538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH APS.005588) |
| Additional Taxonomies | 251B00000X Case Management |
| 251S00000X | |
| Enumeration Date | 2024-08-31 |
| Last Update Date | 2024-10-12 |