| NPI | 1609363506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 12518A) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2026-06-24 |