| NPI | 1669337564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YS0200X Counselor, School | |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2025-12-22 |
| Last Update Date | 2025-12-22 |