| NPI | 1578714705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: BCBA Cert. # 1-04-17) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW123828) |
| 103K00000X Behavior Analyst (Licence: MD LBA281) | |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2016-12-08 |