| NPI | 1699054502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-09-5055) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL PY8302) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2022-07-13 |