| NPI | 1477905263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2303469) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.2103074) |
| 106S00000X Behavior Technician | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2023-04-27 |