| NPI | 1003438268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TX 8133) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 103K00000X Behavior Analyst (Licence: NC 2647) | |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2025-05-15 |