| NPI | 1316936164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00030270) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WA MD00030270) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2019-07-26 |