| NPI | 1265756043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-08-4236) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA 60099445) |
| Enumeration Date | 2010-03-23 |
| Last Update Date | 2010-03-23 |