| NPI | 1386270114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0019208) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0018246) |
| 106S00000X Behavior Technician (Licence: CO RBT-20-115177) | |
| Enumeration Date | 2020-03-12 |
| Last Update Date | 2023-06-20 |