| NPI | 1790229524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: OR ABA-AB-10226421) |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2024-02-29 |