| NPI | 1164912283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103K00000X Behavior Analyst | |
| 103TF0000X Psychologist, Family | |
| 106E00000X Assistant Behavior Analyst | |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2018-05-14 |