| NPI | 1851826523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: ND L108) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MN CC03306) |
| 101YM0800X Counselor Mental Health (Licence: NE 11110) | |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2022-08-25 |