| NPI | 1336655331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 1613555) |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2024-05-20 |