| NPI | 1306481544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH CDCA.120172) |
| Enumeration Date | 2019-11-12 |
| Last Update Date | 2024-10-22 |