| NPI | 1922551589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 19610) |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2025-12-16 |