NPI | 1225434475 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL BCBA1-20-42794) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL AR9292665) |
Enumeration Date | 2014-11-17 |
Last Update Date | 2024-05-08 |