| NPI | 1306343454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.2204408-TRNE) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2022-11-29 |