| NPI | 1245782408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1-05-2292) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY002770) |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2016-11-03 |