| NPI | 1962814558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH14595) |
| Additional Taxonomies | 103TP0016X Psychologist, Prescribing (Medical) |
| 103K00000X Behavior Analyst (Licence: FL IMH14595) | |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2021-04-09 |