| NPI | 1902410798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CO LPCC.0023630) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2025-07-08 |