| NPI | 1659819043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-19-36783) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2023-05-01 |