| NPI | 1003131178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MA 101-0626) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MA 6749) |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2010-04-01 |