| NPI | 1215358767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NM 0159481) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0159481) |
| 101YP2500X Counselor, Professional (Licence: NM 0159481) | |
| 101YS0200X Counselor, School (Licence: NM 226742) | |
| 103K00000X Behavior Analyst (Licence: NM 226742) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2014-01-01 |
| Last Update Date | 2014-01-01 |