| NPI | 1902544141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OH 2022) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH QMHS) |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2022-06-01 |