| NPI | 1881123685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL SW13480) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: FL SW13480) |
| 103K00000X Behavior Analyst (Licence: FL SW13480) | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical (Licence: FL SW13480) | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2022-07-21 |