| NPI | 1487040614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ME XL8557) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2026-01-24 |