| NPI | 1346732096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 251B00000X Case Management (Licence: OH 187579) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 225C00000X Rehabilitation Counselor | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2025-09-26 |