| NPI | 1851891444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2102139-TRNE) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2021-11-01 |