| NPI | 1083010565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: AL 2021-061) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2023-10-12 |