| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 103TF0200X Psychologist Forensic |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP2500X Counselor Professional |
| 103T00000X Psychologist |
| 101YS0200X Counselor School |
| 103K00000X Behavior Analyst |
| 103TC1900X Psychologist Counseling |
| 103TF0000X Psychologist Family |
| 103TP0016X Psychologist Prescribing (Medical) |
| 103TR0400X Psychologist Rehabilitation |
| 225XM0800X Occupational Therapist Mental Health |
| 261QP2300X Clinic/Center Primary Care |
| 3104A0625X Assisted Living Facility Assisted Living, Mental Illness |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2023-08-12 |