| NPI | 1558044321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2507280) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH C.2405853-TRNE) | |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2025-11-13 |