| NPI | 1881104180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 101YM0800X Counselor Mental Health | |
| 104100000X Social Worker | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2017-10-02 |