| NPI | 1962071746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: KY 292333) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: KY RBT-21-173239) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2024-06-04 |