| NPI | 1629510680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| 101YM0800X Counselor Mental Health | |
| 106E00000X Assistant Behavior Analyst | |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2018-05-14 |