| NPI | 1790273027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CTB-2022-0676) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2022-09-07 |