| NPI | 1083487979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: NV RBT-23-296429) |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2025-05-13 |