| NPI | 1306458989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OH RBT-19-84874) |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2024-01-17 |