| NPI | 1457206344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: NY 129938-01) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NY 129938-01) |
| 104100000X Social Worker (Licence: NY 129938-01) | |
| Enumeration Date | 2026-03-04 |
| Last Update Date | 2026-03-04 |