| 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 |