| NPI | 1437766755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OH RBT-20-134673) |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2022-07-12 |