| NPI | 1417259995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NV CI5044) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2010-12-03 |
| Last Update Date | 2022-03-29 |