| NPI | 1366719056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: LA 103k00000x) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: LA 146n00000x) |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2011-11-23 |