| NPI | 1790250223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.2002694) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101Y00000X Counselor (Licence: OH C.1901749-TRNE) | |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2020-10-15 |