| NPI | 1144595737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TR0400X Psychologist, Rehabilitation |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2012-03-14 |
| Last Update Date | 2012-03-14 |