| NPI | 1871009647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 192901) | |
| Enumeration Date | 2017-12-15 |
| Last Update Date | 2025-12-10 |