| NPI | 1093115644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: FL MH17276) |
| 106S00000X Behavior Technician (Licence: FL 16-20955) | |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2021-06-24 |