| NPI | 1386419810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OH RBT-23-282915) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-11-15 |
| Last Update Date | 2025-09-19 |