| NPI | 1083030217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NE 1-16-21607) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10207) |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2024-05-10 |