| NPI | 1487812525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL MH10407) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH10407) |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2018-04-17 |