| NPI | 1396957882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: IL 071-007297) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: KY 269565) |
| 103K00000X Behavior Analyst (Licence: WI 282-140) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2021-11-03 |