| NPI | 1356792675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL arnp9399195) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL MH13994) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2024-06-25 |