| NPI | 1538678172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH17691) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 8736-125) |
| 106S00000X Behavior Technician | |
| 101YP2500X Counselor, Professional (Licence: TX 87580) | |
| 101YP2500X Counselor, Professional (Licence: AZ LPC-21930) | |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2025-10-13 |