| NPI | 1932764065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 251B00000X Case Management | |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2025-06-19 |