| NPI | 1518522846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0021945) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0021945) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2025-02-20 |