| NPI | 1225635550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2021-12-29 |