| NPI | 1326580168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: HI MHC-826) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: HI RBT-16-25705) |
| Enumeration Date | 2016-11-10 |
| Last Update Date | 2024-11-18 |