| NPI | 1518435684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 011720681) |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2024-01-16 |