NPI | 1316411416 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OH CMS) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH QMHS) |
Enumeration Date | 2019-01-11 |
Last Update Date | 2019-01-11 |