NPI | 1972950640 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-18-30151) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2016-05-23 |
Last Update Date | 2021-12-13 |