| NPI | 1659629210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IN 39003125A) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2023-11-07 |