| NPI | 1013496223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.192506) | |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2025-07-31 |