| NPI | 1982229167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC 10367) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2025-07-30 |