NPI | 1811513393 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH21582) |
Additional Taxonomies | 103K00000X Behavior Analyst |
106S00000X Behavior Technician | |
Enumeration Date | 2020-06-22 |
Last Update Date | 2023-12-31 |