| NPI | 1568777811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH 5580) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2017-04-11 |