| NPI | 1295198364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL MH18482) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH18482) |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2021-04-06 |