NPI | 1922374545 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103K00000X Behavior Analyst (Licence: UT 870705-2506) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2012-03-28 |
Last Update Date | 2018-12-18 |