| NPI | 1437553096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1-21-47760) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2014-10-10 |
| Last Update Date | 2021-03-22 |