| NPI | 1346650488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NY 001920-01) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2025-04-09 |