| NPI | 1114485984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 86854) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2022-01-11 |