| NPI | 1982004503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701006356) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701006356) |
| 101Y00000X Counselor (Licence: VA 0701006356) | |
| 103K00000X Behavior Analyst (Licence: VA 0701006356) | |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2017-02-07 |