| NPI | 1225584360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NJ 1-12-12639) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 05684) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2024-08-15 |