| NPI | 1124873104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH23314) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-05-29 |