| NPI | 1073951786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NV CP2985) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2022-03-04 |