| NPI | 1699595223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH APS.005647) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OH 2024) |
| Enumeration Date | 2024-10-17 |
| Last Update Date | 2024-10-17 |