| NPI | 1184016388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MA LABA10000153) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WA BA61229386) |
| 171400000X Health & Wellness Coach (Licence: A-3344727) | |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2024-07-01 |