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 |