| NPI | 1912795949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103TC1900X Psychologist, Counseling | |
| 103TE1100X Psychologist, Exercise & Sports | |
| Enumeration Date | 2025-04-29 |
| Last Update Date | 2025-04-29 |