| NPI | 1366918138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101Y00000X Counselor |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2019-09-20 |