| NPI | 1679851505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NE 4017) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 4017) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2012-02-14 |