| NPI | 1174061758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 102L00000X Psychoanalyst |
| 103K00000X Behavior Analyst | |
| 1041C0700X Social Worker, Clinical | |
| 106E00000X Assistant Behavior Analyst | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2017-02-03 |