NPI | 1871246199 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health |
Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-22-201167) |
Enumeration Date | 2022-01-27 |
Last Update Date | 2025-07-30 |