| NPI | 1134170236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH10729) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103K00000X Behavior Analyst (Licence: FL BCBA1-19-36158) | |
| 104100000X Social Worker | |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2021-11-19 |