| NPI | 1427218585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: IL 1-12-12128) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 01017) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2013-03-05 |