| NPI | 1144676800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: HI BA-378) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2020-09-25 |