| NPI | 1528618279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: HI MHC-880) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-09-15 |
| Last Update Date | 2022-08-02 |