| NPI | 1962173617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: OH OCPSA.161458) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OH OCPSA161458) |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2023-06-06 |