| NPI | 1437979820 |
|---|---|
| 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.005411) | |
| Enumeration Date | 2024-10-11 |
| Last Update Date | 2024-11-13 |