| NPI | 1144580960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-11-9431) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA PCC5297) |
| Enumeration Date | 2012-05-26 |
| Last Update Date | 2018-07-19 |