| NPI | 1326148875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL MH10549) |
| Additional Taxonomies | 104100000X Social Worker |
| 101YM0800X Counselor Mental Health (Licence: FL MH 10549) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-09-02 |