| NPI | 1316293574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NV 13k0000x) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: NV 103trx040x) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2012-07-25 |