| 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 |