| NPI | 1205070166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC006387) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-12-12287) |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2024-01-19 |