| NPI | 1023753381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CG61474169) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2022-05-02 |
| Last Update Date | 2023-08-30 |