| NPI | 1043647076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R3010) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: OR R3010) |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2015-10-18 |