| NPI | 1215404579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2103686) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2002481-TRNE) |
| 101YM0800X Counselor, Mental Health (Licence: OH C.2002481-TRNE) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2021-08-30 |