| NPI | 1720327158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH24567) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WY 1682) |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2025-06-18 |