| NPI | 1972704286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH8156) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: FL MH8156) |
| 103K00000X Behavior Analyst (Licence: FL MH8156) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2024-04-26 |