| NPI | 1982109567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2507499) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2026-05-05 |