| NPI | 1598391773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.2305572) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2023-12-05 |