| NPI | 1861898850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0014293) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2022-06-06 |