| NPI | 1164504643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-21-56731) |
| Additional Taxonomies | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: FL SI 1202) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2022-07-08 |