| NPI | 1851806699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401226398) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MI RBT-17-44099) |
| 101YM0800X Counselor, Mental Health (Licence: MI 6451023025) | |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2026-07-27 |