| NPI | 1174355192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL mh18128) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 1-14-10223) |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2024-08-20 |