| NPI | 1003608787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2507322-TRNE) |
| Enumeration Date | 2025-05-20 |
| Last Update Date | 2026-01-26 |