| NPI | 1083846562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: PA PN276101) |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2015-02-20 |