| NPI | 1134702657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NV CI5461) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: NV RBT-21-165986) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2026-01-20 |