| NPI | 1720212293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2009-05-12 |