| 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 |