| NPI | 1245657139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL MH10259) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH10259) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2018-05-15 |