| NPI | 1104309335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: OH OCPSA.161356) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2018-09-13 |
| Last Update Date | 2019-10-25 |