| NPI | 1710470661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 169288) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2021-06-10 |