| NPI | 1275804304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-07-3520) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 3409) |
| Enumeration Date | 2012-01-20 |
| Last Update Date | 2014-10-08 |