| NPI | 1649476383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MA 1-06-2768) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 1548) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2014-01-10 |