| NPI | 1548546369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL BCBA1-16-22872) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH14969) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2019-06-12 |