| NPI | 1477797900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-21-49228) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 0-10-3937) |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2021-05-03 |