| NPI | 1174068613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 247200000X Technician, Other |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2020-10-30 |