| NPI | 1235777111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 92999) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2024-05-29 |