| NPI | 1861774887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TX 8005) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 12124) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2025-02-12 |