| NPI | 1720620750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: ID 46949) |
| Enumeration Date | 2019-10-10 |
| Last Update Date | 2021-10-22 |