| NPI | 1205257466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-21-47012) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH15092) |
| Enumeration Date | 2013-12-13 |
| Last Update Date | 2026-03-09 |