| NPI | 1164142881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2022-09-01 |
| Last Update Date | 2022-09-01 |