| NPI | 1619576154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NV CI5237) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: NV RBT-20-141224) |
| Enumeration Date | 2020-10-24 |
| Last Update Date | 2023-01-31 |