| 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 |