| NPI | 1689385122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: OH 161764) |
| Enumeration Date | 2022-12-06 |
| Last Update Date | 2025-11-04 |