| NPI | 1679762082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MS 1548) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-11-9380) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2012-11-02 |