| NPI | 1194021782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NY 119-402-1782) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2024-10-21 |