| NPI | 1083199434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106S00000X Behavior Technician | |
| 225400000X Rehabilitation Practitioner | |
| 101Y00000X Counselor | |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2023-06-16 |