| NPI | 1336508191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH 344) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NH 1-13-12797) |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2018-07-13 |