| NPI | 1386088730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY P131625) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NY 1107207) |
| Enumeration Date | 2013-04-28 |
| Last Update Date | 2026-05-08 |