| NPI | 1770719957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SD LPC-MH2179) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY LPC1014) |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2009-06-02 |