| NPI | 1285713685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MA 882) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: 1-04-1493) |
| 103K00000X Behavior Analyst (Licence: MA 1-04-1493) | |
| Enumeration Date | 2006-11-04 |
| Last Update Date | 2016-09-03 |