| NPI | 1134612187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2023-02-06 |