| NPI | 1578822896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL MH9218) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 4881) |
| 101YM0800X Counselor, Mental Health (Licence: FL MH9218) | |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2018-02-22 |