| NPI | 1487026662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH 13657) |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2021-10-06 |