| NPI | 1255119962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.2506506-TRNE) |
| Enumeration Date | 2023-09-15 |
| Last Update Date | 2025-01-21 |