| NPI | 1538678172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: FL MH17691) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2023-04-21 |