| NPI | 1710153143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CO 1-12-10115) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 6377) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2018-05-30 |