NPI | 1629505573 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH61560733) |
Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 79828) |
103K00000X Behavior Analyst (Licence: TX 1479) | |
103K00000X Behavior Analyst (Licence: CO 1-14-17593) | |
225700000X Massage Therapist (Licence: TX MT034888) | |
Enumeration Date | 2017-05-22 |
Last Update Date | 2025-06-09 |