| NPI | 1720707383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2406559) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2405517-TRNE) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2025-01-06 |