| NPI | 1588934178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OH 300088036) |
| Additional Taxonomies | 171W00000X Contractor (Licence: OH 300068038) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2015-05-07 |