| NPI | 1073925509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MA LABA10000590) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2024-02-02 |