| NPI | 1659789980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MA RN253989) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: RI RN48034) |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2024-09-19 |