| NPI | 1467882142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-16-23173) |
| Additional Taxonomies | 225A00000X Music Therapist (Licence: 10547 - MT-BC) |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2016-09-26 |