| NPI | 1821433434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH11765) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAP4081) |
| 101YP2500X Counselor, Professional (Licence: FL MH11765) | |
| 103K00000X Behavior Analyst (Licence: FL MH11765) | |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2023-09-12 |