| NPI | 1811664980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LAC-22838) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2024-06-13 |