| NPI | 1609223569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: FL MH20298) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 20298) |
| 101YM0800X Counselor, Mental Health (Licence: FL 20298) | |
| 106S00000X Behavior Technician (Licence: FL RBT-18-48748) | |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2022-03-16 |