| NPI | 1366136533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 175T00000X Peer Specialist (Licence: OH APS.006727) | |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2025-08-12 |