| NPI | 1891327383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: A2107016) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: AR 19-77966) |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2022-01-17 |