| NPI | 1508362195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 280269-6009) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2020-04-30 |