| NPI | 1871083469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH22549) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-18-53308) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2024-06-18 |