| NPI | 1821316035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 003311) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-17-28638) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2018-07-06 |