| NPI | 1215742457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS 04905) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2025-02-12 |
| Last Update Date | 2025-02-18 |