| NPI | 1942667605 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OK RBT20137061) |
| 374700000X Technician | |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2024-10-21 |