| NPI | 1417222407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL PMH975) |
| Enumeration Date | 2012-03-09 |
| Last Update Date | 2016-05-25 |