| NPI | 1245078591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 374U00000X Home Health Aide | |
| 101Y00000X Counselor | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.192590) | |
| Enumeration Date | 2024-07-19 |
| Last Update Date | 2025-09-12 |