| NPI | 1770300808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 106S00000X Behavior Technician (Licence: OH RBT-24-322945) | |
| Enumeration Date | 2024-09-20 |
| Last Update Date | 2025-07-28 |