| NPI | 1306619184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.2507237) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2023-11-02 |
| Last Update Date | 2025-12-18 |