| NPI | 1366607640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0116721) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2024-02-01 |