| NPI | 1780172908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101Y00000X Counselor |
| 103TH0100X Psychologist Health Service | |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2018-04-24 |