| NPI | 1295191096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-23-67198) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2016-01-08 |
| Last Update Date | 2023-09-12 |