| NPI | 1902444854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: pc010102) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: PA 1-25-79432) |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2026-07-31 |