| NPI | 1306810882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 017636300) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW0004511) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2019-08-02 |