| NPI | 1790291011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: HI MHC-726) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: HI RBT-15-07111) |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2024-07-11 |