| NPI | 1518389477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 67315) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-12-12180) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2014-01-13 |