| NPI | 1861516379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TN 11750) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WY BA-004) |
| 103TC1900X Psychologist, Counseling (Licence: TN 11750) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2025-06-26 |