| NPI | 1598200974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-23-289260) |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2023-10-25 |