| NPI | 1558505065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 247200000X Technician, Other | |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2021-12-24 |