| NPI | 1871265256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH TU810033) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2025-10-28 |