| NPI | 1265879944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL C234-510-90-098-0) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2021-11-01 |