| NPI | 1942672589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 104100000X Social Worker |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2024-07-15 |