| NPI | 1013633452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2305133-TRNE) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 175T00000X Peer Specialist (Licence: OH YPS.000005) | |
| Enumeration Date | 2022-10-18 |
| Last Update Date | 2023-09-07 |