| NPI | 1316570922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YM0800X Counselor, Mental Health | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2020-02-21 |
| Last Update Date | 2023-06-28 |