| NPI | 1033791934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 106S00000X Behavior Technician | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2023-09-05 |