| NPI | 1104195650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 6437) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2017-11-06 |