| NPI | 1942766043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6451023725) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2024-08-05 |