| NPI | 1861885907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-19-38715) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| Enumeration Date | 2015-03-13 |
| Last Update Date | 2019-12-26 |