| NPI | 1659822096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AK 199601) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 101YM0800X Counselor, Mental Health (Licence: LA 8197) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2023-01-10 |