| NPI | 1770156697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 103K00000X Behavior Analyst | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2025-05-30 |