| NPI | 1770300808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OH RBT-24-322945) |
| Enumeration Date | 2024-09-20 |
| Last Update Date | 2024-11-14 |