| NPI | 1013219690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 14139) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH10256) |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2010-12-02 |
| Last Update Date | 2019-09-09 |