| NPI | 1770205569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OH CDCA.183096) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH APS.003556) |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2023-01-10 |