| NPI | 1295079051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2012-11-19 |