| NPI | 1164969523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-16-22056) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 77558) |
| 103K00000X Behavior Analyst (Licence: TX 2338) | |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2021-12-09 |