| NPI | 1871085183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID 8331637) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2026-06-02 |