| NPI | 1134441496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: AZ BA-50) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: AZ 1-09-5601) |
| 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-2701) | |
| Enumeration Date | 2010-02-26 |
| Last Update Date | 2012-02-23 |