| NPI | 1821316613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 1239) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-08-4859) |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2014-02-02 |