| NPI | 1063059095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 171W00000X Contractor | |
| Enumeration Date | 2019-12-10 |
| Last Update Date | 2019-12-10 |