| NPI | 1780694554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-01-0504) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2019-10-19 |