| NPI | 1639434582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NV 1-19-35356) |
| Additional Taxonomies | 101Y00000X Counselor |
| 106S00000X Behavior Technician (Licence: NV RBT-16-16491) | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2022-07-07 |