| NPI | 1366798241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA e3172673) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA e3172673) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2012-08-01 |