| NPI | 1689096380 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 103K0000X) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2024-10-04 |