| NPI | 1538743026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1-23-67146) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA LPC013227) |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2023-08-02 |