| NPI | 1255946729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-20-43537) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH20752) |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2022-07-27 |