| NPI | 1376093930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0016908) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2026-07-06 |