| NPI | 1710214507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR c4796) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR c4796) |
| 103K00000X Behavior Analyst | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2009-11-16 |
| Last Update Date | 2018-06-16 |