| NPI | 1467801449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MA 489092) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 300468) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2016-06-09 |