| NPI | 1588211296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH21610) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-19-95059) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2024-06-28 |