| NPI | 1316495302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: 2014028525) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2016-09-19 |
| Last Update Date | 2022-07-21 |