| NPI | 1104282185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 13982808-6009) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2024-07-17 |