| NPI | 1548569817 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E-0900072) | 
| Enumeration Date | 2011-03-25 | 
| Last Update Date | 2025-05-01 |