| NPI | 1114540994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0734000483) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2020-05-27 |