| NPI | 1407246127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701006290) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: VA PBSF 168) |
| Enumeration Date | 2015-02-02 |
| Last Update Date | 2021-08-12 |