| NPI | 1447650775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MN 1075593-1-HCBS) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 1075593-1-HCBS) |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2014-08-22 |