| NPI | 1215300843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: ND 72) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10727) |
| 103K00000X Behavior Analyst (Licence: MN 116) | |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2025-04-14 |