| NPI | 1861892937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 512) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 101YM0800X Counselor, Mental Health (Licence: NE 10398) | |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2015-09-23 |