| NPI | 1912696030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR R11780) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2023-05-04 |
| Last Update Date | 2025-10-28 |