| NPI | 1316650765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: HI MHC-1194) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: HI RBT-22-250360) |
| Enumeration Date | 2022-12-30 |
| Last Update Date | 2026-02-09 |