| NPI | 1881052132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NV 0205087556) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: NV 0205087556) |
| Enumeration Date | 2016-02-02 |
| Last Update Date | 2018-03-17 |