| NPI | 1316360175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH21855) |
| Enumeration Date | 2014-01-30 |
| Last Update Date | 2023-02-11 |