| NPI | 1033642400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 14950) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL MH 14950) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2017-04-04 |