| NPI | 1154960961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103K00000X Behavior Analyst | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2019-12-26 |
| Last Update Date | 2019-12-26 |