| NPI | 1538572375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: PA PC007481) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: PA PC007481) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2014-06-10 |