| NPI | 1174869887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-21-48283) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2021-03-17 |