| NPI | 1477793503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: KY 11415658) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2023-04-07 |