| NPI | 1801013032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2023-06-21 |