NPI | 1306603758 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 251S00000X Community/Behavioral Health |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OH 171M00000X) |
Enumeration Date | 2024-03-04 |
Last Update Date | 2024-05-30 |