| NPI | 1760610653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-00-0276) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: HI 27) |
| 101YP2500X Counselor Professional (Licence: NC 2935) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2009-06-30 |