| NPI | 1275802654 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 91658) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 63754) |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2022-06-15 |