| NPI | 1316581176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC70006537) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2026-05-12 |