| NPI | 1699743351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-03-1383) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: FL 1-03-1383) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2009-04-10 |