| NPI | 1407435589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OH 2021) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH QMHS) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2021-04-06 |