| NPI | 1992428353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: OH QMHS) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH QMHS) |
| 171M00000X Case Manager/Care Coordinator (Licence: OH 2022) | |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2022-10-20 |