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 |