| NPI | 1336847458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TN 7752) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TN 7752) |
| 106S00000X Behavior Technician | |
| 175T00000X Peer Specialist | |
| 374700000X Technician | |
| Enumeration Date | 2023-02-17 |
| Last Update Date | 2025-08-14 |