| NPI | 1144870023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2024-10-23 |