| NPI | 1467861419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: RBT-18-50382) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH13863) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2020-06-12 |