| NPI | 1699077651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OK 1578690137) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: OK 1578690137) |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2010-11-24 |