| NPI | 1205415841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH CDCA184237) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 171M00000X Case Manager/Care Coordinator | |
| 175T00000X Peer Specialist (Licence: OH APS.003420) | |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2023-12-06 |