| NPI | 1912916289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH5950) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL MH5950) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2023-06-12 |