| NPI | 1033413315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-01-0707) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 2389) |
| 101YM0800X Counselor, Mental Health (Licence: FL MH 4420) | |
| Enumeration Date | 2010-12-31 |
| Last Update Date | 2010-12-31 |