| NPI | 1376991968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH-14987) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL PMH 1274) |
| 103K00000X Behavior Analyst (Licence: FL MH-14987) | |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2021-03-17 |