| NPI | 1669193983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2025-06-30 |