| NPI | 1407517170 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 106S00000X Behavior Technician | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-01-05 |
| Last Update Date | 2023-09-14 |