| NPI | 1043564032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2020-02-28 |