| NPI | 1861981862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.014239) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C7305) |
| 106S00000X Behavior Technician (Licence: IL RBT-17-37937) | |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2023-08-01 |