| NPI | 1144591306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 247200000X |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2023-07-21 |