| NPI | 1790230449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 02077-i) |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2023-06-06 |