| NPI | 1467440230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TN 1-02-0765) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TN LPC00732) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: TN PE0000011472) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2009-06-24 |