| NPI | 1487121760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC A22969) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-18-68398) |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2026-08-27 |