| NPI | 1225327943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-11-8928) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2022-03-22 |