| NPI | 1649856428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: ND 1205-6-15-22A) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2022-12-13 |