| NPI | 1124414321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2019-10-14 |