| NPI | 1427481142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 95044) |
| Additional Taxonomies | 171W00000X Contractor |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2026-03-03 |