| NPI | 1104680651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: OH RA.163728) |
| Enumeration Date | 2024-02-06 |
| Last Update Date | 2025-08-12 |