| NPI | 1447412440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: SC 1-04-1487) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NC 2220) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2017-06-15 |