| NPI | 1710658612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MO 2023033771) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2023-12-08 |