| NPI | 1215277710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MD 1-11-8711) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD 1-11-8711) |
| Enumeration Date | 2013-02-20 |
| Last Update Date | 2015-06-18 |