| NPI | 1801559919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.2608268) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OH RBT-21-188967) |
| Enumeration Date | 2021-10-15 |
| Last Update Date | 2026-08-15 |