| NPI | 1518600923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG61331863) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK W083612028) | |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2023-01-16 |