| NPI | 1508422726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC014551) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: GA rbt-19-85867) |
| 106S00000X Behavior Technician (Licence: GA 19-85867) | |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2024-07-23 |