| NPI | 1205263274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MA 302897) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MA 302897) |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2013-10-04 |