| NPI | 1063951564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: 011183793) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2024-05-24 |