| NPI | 1770842106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WY 1350) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WY 022) |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2026-03-07 |