| NPI | 1134594633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 12959) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2015-12-09 |