| NPI | 1124322011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH12050) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2011-01-06 |
| Last Update Date | 2019-07-27 |