| NPI | 1851806699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6451023025) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MI RBT-17-44099) |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2023-05-20 |