| NPI | 1316628464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6451024269) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YP2500X Counselor, Professional (Licence: OH C.2405732-TRNE) | |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2026-07-29 |