| NPI | 1760614010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701003931) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: VA 0701003931) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2022-01-27 |