| NPI | 1407340912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 7460) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YS0200X Counselor, School | |
| 101Y00000X Counselor | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2020-02-27 |