| NPI | 1225530058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: HI MHC-801) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2021-09-09 |