| NPI | 1770047805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NV MI4391) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 172V00000X Community Health Worker | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2024-07-23 |