| NPI | 1679234892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.2406440) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OH CDCA.179784) |
| 171M00000X Case Manager/Care Coordinator (Licence: OH CDCA.183668) | |
| Enumeration Date | 2022-01-10 |
| Last Update Date | 2024-08-30 |