| NPI | 1598123994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0014535) |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2018-07-20 |