| NPI | 1922357227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 13328) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 11833858) |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2022-11-18 |