| NPI | 1659776201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NY 000045) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 005193) |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2014-10-24 |