| NPI | 1477878247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-04-1928) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW 5443) |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2017-01-03 |