| NPI | 1386763530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NV LBA0027) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: NV SP620) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2015-06-22 |