| NPI | 1871930651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: ND L26) |
| Additional Taxonomies | 174400000X Specialist |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2022-06-30 |