| NPI | 1003483801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH24812) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-21-165002) |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2025-02-20 |