| NPI | 1033584016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 1041C0700X Social Worker Clinical (Licence: IL 149.022778) | |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2024-07-05 |