| NPI | 1194235697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT 25784) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 171M00000X Case Manager/Care Coordinator | |
| 225C00000X Rehabilitation Counselor (Licence: MT 00118429) | |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2023-07-10 |