NPI | 1780259689 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc04942) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
106S00000X Behavior Technician | |
Enumeration Date | 2021-05-24 |
Last Update Date | 2025-05-22 |