| NPI | 1811878051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.2506573-TRNE) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2025-09-11 |
| Last Update Date | 2026-08-03 |