| NPI | 1245845650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2020-09-11 |