| NPI | 1639883366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 100212) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: TX 22-212021) |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2025-12-23 |