| NPI | 1538832571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YS0200X Counselor, School (Licence: OH 1538832571) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH C.2203861-TRNE) | |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2024-01-29 |