| NPI | 1295382075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106H00000X Marriage & Family Therapist (Licence: OH M.2400089-TEMP) | |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2025-07-13 |