| NPI | 1558731323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MA 3296-MH-B1) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2020-11-20 |