| NPI | 1407361421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ND 10269152145) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2024-05-21 |