| NPI | 1588005870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TX 2362) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 68436) |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2019-08-31 |