| NPI | 1780964007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NV 17347) |
| 103K00000X Behavior Analyst | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2024-03-15 |