| NPI | 1689959165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-04-1685) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH 6363) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2023-08-01 |