| NPI | 1396194015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MI RBT-18-50912) |
| 247200000X Technician, Other | |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2021-04-17 |