| NPI | 1184175507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-18-31232) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 114063) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2019-07-02 |