| NPI | 1295189488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: WI 144-140) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 8690-125) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2023-06-13 |