| NPI | 1639400880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: UT 6148541-6004) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C2057) |
| 103K00000X Behavior Analyst (Licence: UT 1-09-5786) | |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2010-01-27 |