| NPI | 1740826734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2022003328) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2025-06-16 |