| NPI | 1316545569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0018941) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH.61473172) |
| 106S00000X Behavior Technician (Licence: HI 521140) | |
| Enumeration Date | 2020-10-10 |
| Last Update Date | 2024-04-19 |