| NPI | 1598306201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 82563) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: 17-40560) |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2021-08-07 |