| NPI | 1164886347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-18-33741) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2024-05-03 |