| NPI | 1902924558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 13966) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-13-13726) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2014-12-04 |