| NPI | 1295207421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NY 003989) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 105611) |
| Enumeration Date | 2018-12-28 |
| Last Update Date | 2025-01-08 |