| NPI | 1639368228 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 106S00000X Behavior Technician | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health | 
| 175T00000X Peer Specialist | |
| Enumeration Date | 2007-10-18 | 
| Last Update Date | 2025-10-27 |