| NPI | 1548926504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106E00000X Assistant Behavior Analyst (Licence: NY 1554292212) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: NY 1554292212) |
| Enumeration Date | 2021-11-15 |
| Last Update Date | 2021-11-15 |