| NPI | 1144526146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2011-02-08 |
| Last Update Date | 2020-05-01 |