| NPI | 1508142621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2015-06-01 |